Looking to the future: the role of assistive technology

Chronic illness and the growing proportion of older people in the population are putting increasing pressure on the NHS¹. The possibilities for future healthcare using assistive technology are vast and likely to impact significantly on the NHS in any doctor’s working career.

Previous articles in Geriatric Medicine Journal have explained the rationale and national framework that would be needed to develop assistive technology (AT) in the UK^1,2. This article expands on these ideas and illustrates what assistive technology would provide for the older person based on their individual needs.

Assistive technology can be defined as ‘any item, piece of equipment, product or system that is used to increase, maintain or improve the functional capabilities and independence of people with cognitive, physical or communication difficulties’³. In simple terms, Assistive technology can be responsive (eg, a respiration monitor or fall detector), supportive (eg, stair lift or reminder unit) or preventive (eg, room occupancy monitor or event monitor)³.

Forms of assistive technology

Home aids

Home aids can support anyone with physical or memory problems and involves the adaptation of the home environment or the introduction of aids to help the individual to perform particular functions or to overcome particular problems⁴. For those with memory problems, simple electronic calendar clocks keep people orientated to the day, the time, whether its afternoon or morning and the season of year; or there are phones with pictures of relatives on ‘fast dial’ buttons so people need not remember telephone numbers. For those with physical illness home aids may include stair lifts, electronic bath hoists, automated door openers, timed curtain closers, movement activated lights and video telephone^4-6.

Detection

Detection is based on the use of biomedical and environmental sensors. Biomedical sensors may detect and alert a call centre to a change in respiratory rate and oxygenation in a patient with COPD or environmental sensors may alert a carer that an elderly incontinent patient needs to be changed by detecting moisture below bed linen.

Older people are at risk of falling and fall detectors may be primary (immediate) or secondary (indirect). Primary fall detectors include worn devices that detect abnormal impacts received by the body. Secondary fall detectors work on the principle that an accident results from departure from normal patterns of activity; for example, a sensor may trigger an alert if there has been no activity detected (activity may be movement on infrared detectors or lack of use of electric appliances, such as the television or kettle) for a certain period of time in the day when there would normally be activity^6,7.

When an alarm is triggered, this is transmitted via the telephone network to a control centre where it is passed on to an appropriate member of a response team according to a previously agreed protocol¹. Another detection possibility is a ‘cyberpet’; this device would provide company for the resident and follow them from room to room, but would also incorporate detection sensors and other functions (eg, spoken messages such as reminding to take medication)⁶.

Controllers

Controllers are devices that enable individuals to moderate their environment remotely. This is already performed every day through examples such as locking a car with a key button or changing the channel on the television with a remote control. But new advances now mean a user can perform the same actions through a blink of the eyelids or a clap of the hands. Such technology can enable a disabled user to live a more independent and safer lifestyle.

The safety aspect comes through technology in other forms, such as smart lighting. To circumvent problems finding a light switch in the dark, a bedside light can be set to come on slowly when someone gets out of bed in the middle of the night and to switch off again when they are settled down again safely. Other devices include electronic door openers, video doorbells, electronic curtain closers, automatic humidifiers and remote controlled central heating.

Cognition and assistive technology

People suffering from various degrees of dementia or conditions such as Alzheimer’s disease can benefit a great deal from cognitive devices. These can be defined as devices that act as electronic reminders or warnings to an individual. The devices can also be used to warn an outside party at the same time. This may be a warden, the police, or even a relative or friend³. Messages for an elderly homeowner can be used to warn them to look both ways if the front door opens out on to the road or even warn that the hot water has reached a dangerously high temperature.

A number of client interfaces have now been developed for cognitive purposes. These include the television, which is readily available. It can be placed in more than one room to provide high quality sound and pictures. Another possible interface is flat screen displays or indeed a cyber pet, as mentioned above³. The internet now also has a large role to play in providing reminders and warnings. For example, refrigerators can now be installed with an internet screen that provides a reminder and easy access to internet shopping based on the contents of the fridge. The fridge can be programmed to automatically order food from the supermarket when it detects that stocks are low on a particular item.

Other devices include sophisticated wireless pendants – or worn alarms – with a range of up to 250 metres⁷. These pendants can place an alert on a designated person’s handset so that they can remind their elderly relative or friend of something that they need to do⁷, such as take their pills.

Electronics

These devices are based on those providing an individual with entertainment. Most of the technology is already in regular use in peoples’ homes. iPods provide easy access to high quality music, video and digital photographs The television provides movies, soap operas and documentaries along with access to digital radio and interactive games.

Television technology has also now advanced to provide video telephoning, enabling people to see their family and friends at the same time they are talking to them. Some of the more exciting technologies are those in robotic pets. Major advances and research in these are currently being carried out in Japan. Some devices can exist in ‘guard-dog’ mode, smoke and fi re detection mode, or ‘pet’ mode for therapy. While the pets have roles to play in detection and cognition they can also provide companionship and some home luxuries, such as fetching slippers.

Conclusion

At present, older people consume a high proportion of health and social care services – in the future this proportion is expected to rise considerably. AT offers a solution to a number of problems faced in housing, social and medical care without a need for additional care resources. High levels of healthcare for the elderly may only be available in the future through the increased use of technology described above. The Audit Commission report³ on assistive technology concludes there is evidence to support its implementation (although is should be noted that most of the evidence is level three or four) and also that it is cost effective.

While there are clearly costs involved, AT is inexpensive compared with the equivalent cost of nursing and care staff^1,3. Another concern has been the ability of older people to manage with the technology described (such technology has existed in one form or another in numerous countries for a number of years, but they have been of limited use and acceptability).

However, the Audit Commission report found a significant proportion of people in sheltered housing operate their own video players and microwaves. Furthermore, it suggests newly retired people are the fastest growing group of internet users³. Indeed, as the technology begins to improve, its usability becomes simpler and the users’ needs become better defined, this technology may change radically and offer both the users and providers acceptable solutions to care delivery in the home⁶.

Key points:

Assistive technology can be defined as any item, piece of equipment, product or system used to increase, maintain or improve a patient’s capability and independence.
Assistive technology can be responsive (eg, a respiration monitor), supportive (eg, stair lift) or preventive (eg, event monitor).
There are many useful innovations in electronics, including video phoning and robotic pets.
Assistive technology offers a solution to problems faced in housing, social and medical care without a need for additional care resources.

Dr Dylan Harris

Dr Pradeep Khanna

References

Rice T (2005) Ten Good Reasons for Assistive Technology. Geriatric Medicine 35:6;19-24
Buckely J (2006) Seven steps to implementing a telecare programme. Geriatric Medicine 36:2;28-31
The Audit Commission (2004). Assistive Technology: Independence and Well Being. London, Audit Commission
Glascock AP, Kutzik DM (2000) Telemedicine Journal 2000; 6:33-44
Doughty K and Fisk MJ (2004) Extending the Role of Telecare and Assistive Technologies in Supporting Vulnerable Groups in the Community 2004;4:22-27
Doughty K, Williams G (2001) Towards a complete home monitoring system. Paper presented at the RoSPA Conference on Safety in the Home
Doughty K (2000) Fall Prevention and Management Strategies Based on Intelligent Detection, Monitoring and Assessment. Paper presented at New Technologies in Medicine for the Elderly, Charing Cross Hospital